Delayed awakening from anesthesia remains one of the biggest challenges that involve anesthesiologists. Most commonly, delayed awakening is due to drugs effects persistence. The time taken to emerge to fully consciousness is affected by patient factors, anesthetic factors, duration of surgery and painful stimulation. Non pharmacological causes may have serious sequel; thus recognizing these organic conditions is important. Unexpected delayed emergence after the use of general anesthesia has a plethora of causes.
The most common cause for delayed awakening following anesthesia is medications and anesthetic agents used in the perioperative period. There may be an over dose of medications. Emergence from anaesthesia depends on the tissue uptake of the drug, average concentration used and the duration of exposure. Certain underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, electrolyte imbalance especially hyponatremia, hypoxia, hypercapnia, central cholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uraemia and severe hypothyroidism may also be responsible for delayed recovery after anaesthesia. Preoperative medications such as opioids and sedatives and hypothermia can further interfere with postoperative recovery. Intraoperative cerebral hypoxia, haemorrhage, embolism or thrombosis also can manifest as delayed awakening from anaesthesia.
The ultimate goal of treatment is to find the cause and treat the cause, but primary management is to maintain airway, breathing and circulation.